Extremity Trauma

Extremity injuries can be divided into upper and lower extremity injuries. As for upper extremity injuries, it is hard to make an estimate of the impact of traumatic injuries to the upper extremities. In the workplace, the number of claims for upper extremity injuries has gone up, accounting for more than 30 percent of all work-related injuries.

In the lower extremities, some of these injuries end up with amputations. There are 1 in every 200 people in the US that has had an amputation. Most are related to vascular disease; however about 15 percent of lower extremity amputations are a result of traumatic injuries.

Extremity trauma is divided into upper and lower extremity trauma. Upper extremity trauma usually involves a fracture of the shoulder or head of the humerus, dislocation of the humerus, humeral shaft fracture, elbow fracture, radial and ulnar fractures and wrist or hand fractures.

Because a person in a motor vehicle accident often brace themselves with their hand, they fracture one or more bones in the upper extremity as the forces push into the hand from the motor vehicle accident and “give” somewhere along the course of the upper extremity.

Upper extremity injuries can also include sprains and nerve injuries, such as carpal tunnel syndrome. Carpal tunnel syndrome occurs when the median nerve is impinged in the carpal tunnel of the wrist because of repetitive trauma or a sudden trauma that damages the carpal tunnel and causes impingement of the nerve.

Lower extremity trauma can be anything from a pelvic fracture, hip fracture, patellar fracture, tibia and fibula fracture, ankle fracture or foot fracture. There can also be dislocations of the patella and the hip. Most of these injuries are caused by motor vehicle accidents. The force of the accident can cause the foot to brace in the foot well of the car, causing fractures of the long bones, the hip or the pelvis. The knee can be where the force originates, leading to things like “dashboard knee” or even a patellar fracture.

The fractures can be displaced or nondisplaced, depending on the injury. Displaced fractures are more severe because the bony fracture segments are not in the correct position. They must be fixed by external reduction or internal reduction (in the operating room). Nondisplaced fractures are easier to repair but still might need surgery for internal fixation of the fracture with plates, screws or rods, among other choices.

Extremity fractures are common fractures that can be caused by any number of injurious conditions. They happen because of the following conditions:

• Automobile injuries
• Motorcycle accidents
• All-terrain Vehicle accidents
• Falls from a great height
• Bicycle accidents
• Altercations
• Falls from a standing position
• Sports-related accidents

These things involve forces that can be so great as to cause an extremity sprain, strain or fracture, the most serious being a fracture.

Symptoms of an extremity fracture vary widely according to the location of the fracture. The pain is usually located to the site of the injury and there can be distal disruption of the nerves or blood vessels in any fracture that causes numbness,, tingling or coldness to the part of the body distal to the fracture.

The main symptoms of an upper extremity fracture are:

• Pain and swelling to the affected area
• Obvious deformity at the site of the fracture
• Inability to affectively use the arm due to problems in the affected area
• Bruising, warmth, or redness of the affected area

The main symptoms of a lower extremity fracture include:

• Inability to walk on the affected leg
• Instability of the leg
• Deformity of the affected area
• Distal coolness, numbness or paralysis of the extremity
• Pain at the site of the fracture

It is up to the attending physician to take a thorough history and physical examination in order to find out the most obvious place of injury and proceed further with diagnostics.

The diagnosis of extremity injuries include first doing a plain film x-ray on the affected area to look for fractures. Most fractures are easy to see on plain film x-ray. In situations in which a fracture is expected but not seen on plain film, a CT scan or MRI scan can look carefully at the bone so that nondisplaced fractures can be seen. The MRI has the added advantage of being able to show any soft tissue damage or hematomas from the injury.

If there is suspected nerve injury, an electromyogram can be done to check the nerve function to muscles distal to the injury. A nerve stimulation test can be done to see if the fracture or other injury had impinged on a nerve. Doppler ultrasound can assess the pulses distal to the injury in order to assess whether or not the arterial blood flow has been injured. This kind of injury requires emergent surgery to restore circulation to the affected arm or leg.

There is first aid and definitive treatment of extremity fractures. The first aid treatment of extremity injuries includes the following:

• Apply ice to the swollen or painful areas
• Do not move the extremity.
• Take Aleve. Advil or Tylenol
• Brace the extremity if you have the tools for that.
• Activate EMS if needed for transport or for other injuries.

Once at the hospital or clinic, the patient needs to have a physical exam, history, and x-rays to determine the site of injury and makeup of fracture. The fracture can be treated with closed reduction and external casting, which is the easiest way to treat minor fractures.

The doctor will use the x-rays to guide putting together the bony ends so that are in anatomic configuration. In addition, a splint or cast needs to be used in order to keep the fracture in anatomic alignment for about 6 weeks. The cast may need to be replaced if there is atrophy of the muscles making the cast not able to keep the fracture ends in anatomic alignment because the cast is too big.

The doctor may rely on open reduction and internal fixation. This means doing surgery to put the fragments of bone into whatever alignment is most appropriate—hopefully completely anatomical. The surgery goes on to use hardware, such as an intramedullary rod, plates and screws, or wires in order to fix the bone into place.

There are multiple techniques for this that differ according to the part of the extremity and type of fracture involved. The patient still takes 3-6 weeks to heal the fracture.

Not all extremity fractures heal perfectly and there can be long-term complications, including:

• Persistent deformity of the extremity
• Lack of complete function of the extremity
• Lack of nerve function distal to the injury
• Poor circulation past the injury
• Amputation secondary to failure of healing of the injury or severe crush injury.

If you or a loved one has suffered extremity trauma as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916.921.6400 to set up a FREE consultation.

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